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The goals of gastrointestinal bleeding scintigraphy are to locate the bleeding site and to determine which patients require aggressive treatment as opposed to those who can be medically managed discount red viagra 200mg line impotence of proofreading. In some patients red viagra 200 mg for sale erectile dysfunction how young, the bleeding site is identified with sufficient confidence for specific surgical inter- vention (e cheap 200mg red viagra erectile dysfunction treatment over the counter. If bleeding is detected buy cheap red viagra 200 mg erectile dysfunction drugs muse, the site is usually localized well enough to direct the next diagnostic test (e. The in vivo/in vitro method can be used, while the in vivo method is not recommended because of potential high free pertechnetate activity giving confusing results. When the study has to be performed at the bedside with a small detector, a diverging collimator is useful in order to include the maximum abdominal area. Patient preparation Patients suspected of acute gastrointestinal bleeding should have blood pressure and heart rate measured upon their arrival in the nuclear medicine department to confirm that they are haemodynamically stable. The patient should have an intravenous catheter in place so that hypotension can be rapidly treated with replacement of fluids or blood. The removal of blood for radiolabelling and re-injection poses the risk of misadministration to the wrong patient. The handling and administration of blood products must be subject to special safeguards and procedures, in order to prevent errors or contamination accidents. Procedure The procedure for gastrointestinal bleeding scintigraphy is as follows: (a) A dynamic acquisition is important in order to accurately localize the bleeding site: —Photopeak, typically a 20% window at 140 keV; —Computer, 128 × 128 matrix. Acquiring these images in multiple sets of 10–15 min each may facilitate review by the physician as the study is in progress. Delayed images are useful in showing subsequent bleeding and categorizing severity, but may result in incorrect localization of the bleeding site. Anterior oblique and posterior views are frequently helpful in deciding if activity is located anteriorly or posteriorly. The precision and accuracy of estimates should be determined for each institution. Interventions Pharmacological intervention is controversial and is not widely used. Glucagon studies have been suggested as an adjunct to gastrointestinal bleeding studies. Glucagon decreases intestinal peristalsis and increases vasodilatation, although it is not widely used. Heparin also has been suggested as an adjunct to gastrointestinal bleeding studies in selected patients with recurrent significant bleeding and negative standard diagnostic tests. Six thousand units of heparin are adminis- tered intravenously as a loading dose, followed by 1000 units every hour. The patient’s baseline coagulation status should be evaluated before giving heparin. Surgical coverage should be immediately available as a precautionary measure and close monitoring of the patient is necessary with protamine sulphate on hand to reverse the effects of heparin. Processing Subtraction and/or contrast enhancement should be used, with no other routine processing parameters to be observed. Subtraction cinematography The first frame or normalized summed set of data can be subtracted from the latter images to improve contrast. Interpretation In addition to patient demographics, the report should include the following information: (a) Reasons why the study was indicated. Use of windowing levels and different colour tables on a computer display further facilitate the detection of subtle abnor- malities. Accurate localization of the bleeding site is dependent upon identification of the focus of initial blood collection, and upon the movement of the blood away from the bleeding site. A lateral, posterior and/or subpubic view is best to help in identifying activity in the rectum that would otherwise not be detected due to overlying bladder activity or soft tissue attenuation. Radioactive urine in the renal pelvis of a transplanted kidney, in either the right or left lower quadrant of the abdomen, may mimic colonic activity. Images of the thyroid and salivary glands can confirm the presence of free 99mTc-pertechnetate as the source of an artefact. Principle A Meckel diverticulum is a vestigial remnant of the omphalomesenteric duct located in the ileum, about 50–80 cm from the ileocecal valve. Technetium-99m pertechnetate avidly accumulates in gastric mucosa and is the study of choice for identifying ectopic gastric mucosa in a Meckel diverticulum. Clinical indications The indication for the study is to localize ectopic gastric mucosa in a Meckel diverticulum as the source of unexplained gastrointestinal bleeding. Patient preparation Pretreatment with histamine H2 blockers is reported to enhance the sensitivity and specificity of the Meckel scan. Histamine H2 blockers (cimetidine and ranitidine) block secretion from the cells and increase gastric mucosa uptake, preventing release and accumulation of the tracer in the intestinal lumen, which constitutes a common cause of false positive studies. An oral dose of 300 mg cimetidine should be administered four times a day for two days in adults, and doses of 20 mg/(kg · day) for two days in children or 10-20 mg/(kg · day) in neonates, prior to starting the procedure. Intravenous cimetidine should be administered at a rate of 300 mg in 100 mL of saline dextrose over 20 min, with imaging starting 1 hour later. Ranitidine dosage is 1 mg/kg for infants, children and adults up to a maximum of 50 mg, infused intravenously over 20 min with imaging starting 1 hour later, immediately after 99m injection of Tc-pertechnetate. This may occur for days after the administration of a stannous pyrophosphate but is usually not a problem with in vitro labelling. Procedure The procedure for Meckel’s diverticulum scintigraphy is as follows: (a) Photopeak: typically a 20% window at 140 keV; Computer: 128 ¥ 128 matrix. Additional static images in the anterior oblique, lateral and posterior views are recommended at the end of the dynamic acquisition. Stopping the acquisition to obtain these images when abnormal activity is first seen can be helpful in distinguishing activity in a Meckel diverticulum from that in the kidney, ureter or bladder. Post-void images can also be helpful in detecting activity in a Meckel diverticulum obscured by the urinary bladder. A urinary catheter can be helpful if the Meckel diverticulum is adjacent to the bladder. Alternatively, the decubitus or upright views may at times cause the diver- ticulum to separate from the bladder. Interpretation Activity in the ectopic gastric mucosa should appear simultaneously with normal gastric mucosa. A Meckel diverticulum may appear anywhere within the abdomen, although it is more often located in the right lower quadrant. Frequently confused with a Meckel’s diverticulum is activity in the kidneys, ureter or bladder. Activity in the urinary tract usually appears after that in the normal gastric mucosa. Pertechnetate that is secreted by the gastric mucosa will gradually accumulate in the small bowel. This activity can be distinguished from that in a Meckel diverticulum by its delay and by its appearance as an area of mildly ill-defined increased activity. It is also helpful to view the dynamic study in cine-mode with an upper threshold adjustment for enhancement of low activity areas. Reporting In addition to patient demographics, the report should include the following information: (a) The indication for the study.

Native Americans National data on racial/ethnic differences in the addiction treatment gap are limited with regard to Native Americans due to small sample sizes 242 for this population discount 200 mg red viagra otc erectile dysfunction medication cheap. However purchase 200mg red viagra with mastercard erectile dysfunction treatment without drugs, existing data suggest that Native Americans are the likeliest of all racial/ethnic groups to smoke and to meet clinical criteria for addiction involving alcohol 243 and other drugs buy red viagra 200 mg low cost erectile dysfunction doctor in miami. National data also suggest that the group with the largest treatment gap is 244 Native Americans purchase red viagra 200 mg visa erectile dysfunction pump surgery. One estimate indicates that less than one-fifth of addiction treatment programs nationally offer specialty services for 245 Native Americans. This spending gap impairs health and imposes extraordinary and unnecessary costs to taxpayers. The continued inadequacy of insurance coverage for these services further flies in the face of a fiscally-sound approach to disease prevention, treatment and management. The Rational Approach to Risky Substance Use and Addiction The goals of medicine are the prevention of disease, the diagnosis and treatment of illness or 1 injury and the relief of pain and suffering. The general standard for determining what health care services should be provided to patients is 2 the “reasonable and necessary” or the 3 “medically necessary” standard. The definition of what is considered necessary generally is made by health care payers based on the strength of the clinical evidence supporting the effectiveness of interventions in improving 4 health outcomes. In the Medicare and Medicaid programs, medical necessity is defined in various ways but generally as the prevention, diagnosis or treatment of illness or injury that endangers life, causes suffering or pain, causes physical deformity or malfunction or results in 5 illness or infirmity. Some states also require that Medicaid services not be more costly than 6 reasonable available alternatives. This ideal is based on several arguments which assert a moral obligation to treat injuries or diseases that Risky substance use and addiction constitute the * 8 leading cause of death and disability in the impede normal functioning. The result of not providing Addiction is not unique as a health condition for effective prevention and treatment services for which a lack of understanding of the nature of addiction is that the cost of addiction accrues, the disease and its causes has resulted in driving many other diseases, later manifesting as assigning blame to the patient and to inadequate more expensive care and spilling out to costly † or misguided interventions; other historical social consequences. However, once a ‡ body of evidence exists about the nature of an Columbia calculated that in 2005, risky illness and how to address it, that information is substance use- and addiction-related spending incorporated into medical practice and accounted for 10. The science is unambiguous-- § addiction is a complex brain disease with treatment. The taxpayer tab for government 11 spending on the consequences of risky substance significant behavioral characteristics that 12 use and addiction alone totals $467. Our continued failure to prevent and treat the disease The Largest Share of Costs Falls to the is inconsistent with ethical standards and the Health Care System goals of medical practice. The largest share of spending on the consequences of risky substance use and 18 addiction is in health care. Persons with addictive diseases are among the highest-cost 19 health care users in America: they have higher utilization rates, more frequent hospital admissions, longer hospital stays and require 20 more expensive health care services. Treatment The health care costs associated with addiction also stem from the impact that addiction has on There are no national data available on total the ability to treat other diseases. Addiction health care spending for screening or ** 34 affects the body in ways that complicate health intervention services; therefore, data on cost care, for example, by weakening the immune savings from these services and from addiction 23 treatment come from individual studies rather system. The cost estimates for treating diabetes, cancer and heart * Including medical, mental health and direct conditions were inflated to 2010 dollars using the treatment costs. According to a 1999 study, the cost Cost-benefit studies of screening and brief * † of providing managed, comprehensive interventions for tobacco and alcohol use among addiction treatment benefits with low co- adults and pregnant women have demonstrated a ‡ 43 payments and no annual limits was $5. Adding managed, studies have demonstrated that medical costs for unlimited addiction treatment benefits to a plan patients with addiction increase significantly as that previously did not offer addiction treatment 44 these patients age, implying that the greatest § benefits would increase costs only by an cost savings can be achieved by early ** 40 §§ 45 estimated 0. In the health Congressional Budget Office estimated that care field, treatment costs of up to $50,000 for mandating parity for mental health and addiction each year of life saved are considered to be a treatment benefits would increase group health worthwhile investment in health (i. Smoking cessation programs yield parity in Federal Employee Health Benefit Plans positive health outcomes at the low cost of have concluded that total plan spending per *** 47 $5,000 per healthy year gained compared to $56,200 per year for Aspirin and statin therapy * Benefits carved out and provided by a large ‡‡ managed behavioral health care organization. Research is presented related to screening and † Including outpatient, intensive outpatient, inpatient interventions for smoking and risky alcohol use. A study of primary especially cost effective, given that the smoking- care screening and brief physician intervention attributable medical care needed by infants for adult risky drinkers yielded a net benefit of 56 whose mothers smoked while pregnant is an $947 per person. A one- percent reduction in the prevalence of smoking The use of screening and brief interventions in in the U. A study of screening and brief § low-birth weight births by 2,000, resulting in interventions for risky alcohol use among adults $21 million in avoided direct medical costs. In The American Legacy Foundation projected that total, the implementation of a hospital-based a reduction in Medicaid costs of nearly one alcohol screening and brief intervention program ** billion dollars could be achieved by preventing for risky alcohol use was estimated to reduce †† the current cohort of 24-year-olds from health care costs by $3. Brief interventions with adolescents were successful in motivating all Medicaid ages 18 and 19 who were admitted to a trauma recipients who smoke to quit, states’ Medicaid center for alcohol-related injuries also have been expenditures would be, on average, 5. An alcohol intervention program costing For 45-year old men with a 10-year risk for $50,000 that could successfully prevent at least coronary heart disease of 7. Consisting of two doctor visits and two nurse † Costs include individually-tailored diet and exercise follow-up calls. Significant declines were seen in hospital stays, generating billions of dollars areas such as the number of inpatient 61 hospital days and emergency department in largely avoidable health care charges. Some research suggests that treatment alcohol or drugs other than nicotine who “pays for itself,” often on the day it is delivered were enrolled in an outpatient treatment † and the total cost savings from addiction program with a control group found that 63 treatment continue to accrue over time. The study 64 are greater than the cost of treatment, also found that treatment can cut health care administrators and policymakers too often costs associated with addiction by about one disregard benefits of treatment that accrue quarter, primarily by reducing the number of beyond the narrow silo of each individual annual hospital stays and the likelihood of 67 government program. The one exception was opioid associated with an annual $2,500 reduction ** maintenance therapy which paid for itself in in medical expenses among adult patients health care savings. Adults who met criteria for addiction involving alcohol or other drugs but did not receive treatment. Most of the reductions in medical examples of the nature of the treatment provided. Following the implementation of Medicaid- covered pharmaceutical therapy for addiction  A performance audit of the costs and involving nicotine, Massachusetts had a 46 savings to the Colorado Medicaid Program-- percent annual decrease in hospitalizations for which in 2006, implemented a benefit to heart attacks and a 49 percent annual decrease in †† 74 provide outpatient addiction treatment for cases of coronary atherosclerosis. Those in the control group depending on the modality of treatment were more likely to have an alcohol-related visit (with long-term residential treatment to the emergency department during the study yielding the greatest reduction in recidivism, compared to patients taking naltrexone (15 72 76 roughly 27 to 34 percent). One study Measured as receiving a clinical diagnosis of alcohol or other drug dependence or psychosis, examined the cost effectiveness of providing receiving detoxification services or having been referred for alcohol or other drug assessment by the state division of alcohol and substance abuse. There were, however, no significant changes in ‡ Analysis based on available Medicaid claims data, rates of hospital admissions for respiratory conditions not a controlled longitudinal study. Recently-enacted federal and state parity laws An examination of health care and pharmacy have expanded coverage for addiction treatment costs for patients with addiction involving where offered, and the Patient Protection and opioids in a large U. Another study projected Federal and state parity laws require private that methadone maintenance therapy costs ‡ 80 insurers that provide mental health and addiction $5,915 for every year of life gained. In general, restrictions placed capacity for heroin users is cost effective, at on addiction services (e. Applies to plan years beginning on or after July 1, ‡ Assuming annual treatment costs of $5,250. Employers including addiction benefits in 97% 97% * most popular plan This includes traditional and benchmark/benchmark Employers placing equivalent managed care plans. Even if they are married, in school or eligible to † Including new small fully-insured or self-insured enroll in their employer’s plan.

Area 2: for extraction of nucleic acids from clinical specimens This area is dedicated to the handling of clinical samples and extraction of nucleic acids red viagra 200 mg sale erectile dysfunction only with partner. Additional equipment needed to perform the activities to be carried out in Area 2 include: A standard clinical centrifuge; A dry heat temperature block; A thermocycler biohazard container for biological waste discount red viagra 200 mg otc erectile dysfunction pills supplements. Other equipment needed in Area 3 includes a microcentrifuge discount 200mg red viagra with visa impotence from steroids, a pH meter order 200mg red viagra with amex impotence zoloft, weighing scales, freezer, refrigerator, hot plate magnetic stirrer, dry heat block and microwave oven. General workflow In order to achieve maximum efficiency it is essential to establish a culture of good practice in a molecular biology laboratory. It should be stored in the refrigerator until needed in the specimen preparation area (Area 2). Specimens and controls are processed in Area 2 and added to the tubes that are placed in the thermocycler. Products are submitted to agarose gel electrophoresis (Area 3 — with options of Southern or dot blot, radioactive labelling and hybridization) in the radiation area. Areas where unsealed radionuclides are used are classified as low, medium or high hazard, the hazard level determining design requirements. Classification of the hazard level involves three steps: (1) Firstly, a decision is made on the maximum activity foreseen for each radionuclide used in each room; (2) This is multiplied by the weighting factor for the respective radionuclide (Table 3. The hazard category is then determined from the weighted activity by referring to Table 3. If more than one radionuclide is to be used, the highest hazard category determined should be applied. The radiation protection requirements for each hazard category are given in Table 3. The design of equipment and the associated appli- cations software have evolved rapidly and, to some extent, continue to be developed. Selection criteria should include flexibility in use, reliability and backup, with features determined by the desired function. It is important to ensure that equipment is specified to meet full requirements and, where possible, contractual conditions are in place to ensure the performance of the delivered system, as confirmed during acceptance testing. Nuclear medicine instruments are particularly sensitive to environmental conditions and conse- quently require strict control of temperature and humidity, as well as a continuous and stable power supply. Regular assessment is required to confirm stable operation using the quality control testing that is achievable in practice. All three aspects (specifications, acceptance testing and routine quality control) are important to ensure effective clinical operation. There are well established criteria for specifi- cation and testing of single photon instrumentation; however, the dual photon imaging field has only developed recently with the introduction of relatively inexpensive coincidence circuits for dual head gamma cameras. The miscellaneous other equipment tends to utilize well established technology, even in the case of relatively new innovations (e. It is beyond the scope of this publication to provide a comprehensive coverage of instrumen- tation. The manual offers introductory information that may provide the reader with an improved understanding of performance specification and testing, referring the reader to more specific texts that can be used for a more detailed study. General considerations The following factors should be considered when purchasing nuclear medicine imaging equipment. An appropriate configuration should be selected to best match the desired end application, bearing in mind that the system may need to be used for other functions at some future date. The availability of specific features, software or accessories that meet the defined function is likely to be one of the main deciding factors in selecting a suitable system. Service availability It is critically important that there be demonstrated service capability in the country and a guaranteed support for the system. In considering the overall cost of a system, maintenance contract costs should be included and considered essential. Competition between companies usually results in very similar specifications, so much so that other factors generally determine the system of choice. Demonstrated capability Care should be taken in selecting completely new designs, as it is common with new systems for problems to manifest themselves that will be resolved in later models. Users should be consulted on the performance of previously installed systems of the same design. Ease of upgrade It is important that systems can be easily upgraded and that software can be updated for several years after purchase. Compatibility In some circumstances, the system purchased should be compatible with existing systems in the department. Advantages include the familiarity of staff with operation, sharing of accessories and proven availability of support. Provision for transferral of data between systems and general networking has increasing importance. Ease of use Ideally, the system should be easy to use, with manual override available for any automatic features (e. Selection of accessories A wide range of accessories is normally available, but should be chosen to meet anticipated needs. However, there are instances where increased cost may be justified in terms of more effective use of the equipment. Contractual considerations When purchasing an imaging system it is imperative that a document be prepared that not only defines the requirements of the system to be purchased but also clearly outlines the obligations placed on both the supplier and the receiving institution. In addition to the specification sheets made available by the vendors, the user should also consider the main studies to be performed on the camera and the specifications necessary to obtain optimal clinical results. Complete operation and service manuals should be supplied with the gamma camera and should remain the property of the user. Appropriate radiation sources and phantoms needed for quality control tests should be purchased at the time of instrument acquisition. Results of acceptance tests, performed immediately after installation, will be compared with these data. Most acceptance tests should be performed by the supplier, under the supervision of, and in cooperation with, a suitably experienced nuclear medicine physicist. All phantoms and test equipment required for acceptance testing should be made available free of charge by the supplier. A clause built into the purchase agreement should specify the procedures to be used during acceptance testing, minimum acceptable results and actions to be taken if acceptance test results do not meet pre-purchase agreements. Training on the operation and programming of the system, including acquisition and processing of patient studies, must be supplied. It should be emphasized that the full installation, including acceptance testing and on-site training, is the responsibility of the supplier. A competent service person from the company, with training on the specified equipment, should be available. Site preparation and installation Before installation takes place, steps should be taken to ensure that the environment is suitable for the installation. These will include the following: (a) The room should be of an appropriate size and in an acceptable condition before installation takes place.

Moreover red viagra 200mg low cost erectile dysfunction vacuum pump demonstration, these scores continued to rise:12-week and daily sessions of therapy generic 200mg red viagra amex impotence from stress, with an average stay of 3 buy cheap red viagra 200mg erectile dysfunction causes of. Conclusion: Robot- in chronic stroke patients and subsequently offers renewed hope based rehabilitation can be applied to patients with acute stroke in and potential for these patients who should no longer be side-lined a clinical setting and may be benefcial for improving the upper as “dead end cases” generic 200mg red viagra with visa erectile dysfunction and alcohol. The treatment group was treated with and lower limb function in post-stroke patients. Two cases of the observation group At the time of discharge, all of the evaluated items showed a statis- off, shedding 4. Three cases of the treatment group tically signifcant improvement relative to the scores at admission. In upper limb function, there was no statistically signif- cidence of shoulder pain in control group increased (p<0. Hiroshi2 1Tokyo Metropolitan University, Graduate School of Human Health Introduction/Background: The program of prolonged stretching Sciences, Tokyo, Japan, 2Hanno-Seiwa Hospital, Rehabilitation in conjunction with local injections of nerve blocking agents after 3 Center, Saitama, Japan, Saitama Medical University, Department stroke aims to improve upper limb function, but current evidence of Neurology and Cerebrovascular Medicine, Saitama, Japan, of functional benefts of exercise for arm function is discussed. We 4 have evaluated the effects of combination of the stretching train- Saitama Medical University, Department of Rehabilitation Medi- ing and local botulinum-toxin injections. Material and Methods: cine, Saitama, Japan 30 patients with post stroke time from 1 to 15 years were investi- Introduction/Background: It is important to be able to predict gated. Were measured the active and passive movements and rest- whether a patient will be able to walking and activities of daily liv- ing angles of paretic upper limb. Analysis was purpose of this study was to classify stroke patients by their prop- made using Mann-Whitney U-test, Wilcoxon matched pairs test erties into several groups, and investigate their association with and Spearman correlation. Material and Methods: Seventy-two frst attack stroke dle and proximal joints of the 2, 3, 4, 5 fngers decreased after 30 patients with severe hemiplegia at admission were included in this days of the treatment (p=0. No relationships between post stroke time rhage in 51 and subarachnoid hemorrhage in 6. We divided stroke patients into group by their properties days of the integrated therapy of the local injections of the botuli- and physical function on admission by the cluster analysis. Age, possibly prevent stroke patients from performing independent daily time from stroke onset, nutritional status, neurological symptom, activities as well as increase the risk of recurrent stroke. Hence, trunk ability and knee extension muscle strength on the non-paretic early interventions incorporating with aerobic training are sug- side at admission were signifcantly difference among the groups. However, this might not be feasible or practical for stroke signifcantly difference among the groups. The purpose of this study was to compare sults suggest that the classifcation of severely hemiplegic stroke the one-leg versus two-leg symptom-limited cycling tests in early- patients is useful to predict prognosis in a rehabilitation hospital. Material and Methods: This study recruited 6 male subacute stroke patients (onset time: 2 weeks to 3 months) with an averaged age of 47. Conclusion: This pilot study sug- Tsukuba, Japan, 4University of Tsukuba Hospital, Department of gests that for subacute stroke patients with very low ftness levels, Neurosurgery, Tsukuba, Japan physiological responses induced by one-leg cycling test are similar to those by two-leg cycling test. More studies to further confrm Introduction/Background: In patients with hemiplegia after stroke, this evidence are needed. Hussein1 dependently maintain standing posture using an All-in-One suspen- 1 Cheras Rehabilitation Hospital, Department of Rehabilitation sion device, and had detectable bio-electric potential from hip fexor Medicine, Kuala Lumpur, Malaysia muscles within 30 days after onset. Involvement of the cardiovascular system particu- 10m walking test and 12 grade recovery grading. Gait changes were larly aortic dilatation and dissection places high risk of morbidity investigated by two-dimensional motion analysis (Dartfsh Software and mortality in individuals with Marfan Syndrome. Material and Methods: Descriptive case report to high- sion angle and stance phase duration of the affected limb. In accord- light the complexities and challenges of stoke rehabilitation of a ance, increased step length and walking velocity,and improvement young individual with Marfan Syndrome. Conclusion: The observation indicates pos- gentleman with Marfan Syndrome was referred to the inpatient re- sibility of enhancing early functional recovery by early intervention habilitation facility for developing a massive right middle cerebral in cases with detectable motor related bio-electric potential. This occurred immediately upon comple- other hand, physical therapy for acute phase stroke rehabilitation tion of Bentall procedure; which was performed to treat his aortic induces neural facilitation by voluntary loading on the affected limb valve and ascending aorta disease. The stroke related impairments were dense left hemiplegia, visuo-spatial defcits and psychological effect with low 426 mood. He endured a Kaohsiung, Taiwan, 2Kaohsiung Municipal Cijin Hospital- Kaohsi- prolonged stroke rehabilitation phase, with strict cardiac precau- ung Medical University, Department of Physical Medicine and Re- tions. He progressively improved and became independent within a habilitation, Kaohsiung, Taiwan, 3Chang Gung University, Physi- course of 6 months. Conclusion: Marfan Syndrome is a connective cal Therapy Department and Graduate Institute of Rehabilitation tissue disease with multi-system complications. This system improves motor functions of the a 20 years old lady who was diagnosed with right acoustic neuroma hemiparetic upper limbs. Here we investigated the effectiveness of and developed neurological defcits (dysphonia, dysphagia, ipsilat- this system in chronic stroke patients. Material and Methods: Par- eral peripheral facial paralysis, ipsilateral hearing loss, contralateral ticipants: The eleven patients (male: female, 6:5; mean age: 65. Six control patients who underwent training without this sys- tine infract after the surgery. Interventions: The patients undergoing dual electrical muscle was diagnosed with left trigeminal schwannoma and developed stimulation of the upper limb and controle patients trained for 60 neurological defcits (dysphagia, contralateral central facial palsy, min per day, 5 days per week for 3 weeks. Main Outcome Meas- contralateral hemiparesis and hemi-sensory defcits) resulted from ure: Outcomes were assessed using the upper extremity compo- left pontine hemorrhage after the surgery. Conclusion: This study demonstrates that our therapies, they achieved moderate to high level of independence one new dual muscle electrical stimulation system may be effective for year after the event. Conclusion: In this case series, we found that rehabilitation of chronic stroke patients experiencing upper limb young age, high motivation and aggressive rehabilitation program paresis. Medical complications such as pain, fatigue and depres- sion should be detected and addressed as soon as possible to enable better participation in rehabilitation program. During treatment, standard hand motion fexors muscles is a common complication in patients after video and instruction voice were given to guide patients. Materials and Methods: A 57 years old female patient A has shown to be an effective antispastic agent. Material and with one-year history of right basal ganglia ischemia was admitted for Methods: An open-label non controlled trial for a duration of 16 her hand weakness. The patients were assessed at baseline, treatment, stretch techniques and some passive movements were of- 2, 4, 12 and 16 weeks after treatment by several outcome meas- fered by therapist. At baseline evaluation, the brain areas, including the bilateral precentral gyrus, postcentral patient was not able to voluntarily extend his any fngers beyond 5 gyrus, middle frontal gyrus, inferior frontal gyrus, thalamus, and degrees. Most importantly, all of our And signifcant increment was also found in the lateralization in- main fndings could be replicated by half verifcation. However, further study was warrant- ed to clarify the effcacy of this combined intervention. J Rehabil Med Suppl 55 Poster Abstracts 129 At age 26 he suffered from gigantic thalamic hemorrhage. Material and Methods: A and Methods: After 1 year treatment in a hospital he returned home prospective randomized controlled study.